Pre-Cushing's syndrome not recognized by conventional dexamethasone suppression-tests in an adrenal 'incidentaloma' patient

M. Torlontano, M. Zingrillo, L. D'Aloiso, M. R. Ghiggi, A. Di Cerbo, A. Scillitani, G. Petracca-Ciavarella, A. Liuzzi

Research output: Contribution to journalArticle

Abstract

Pre-Cushing's syndrome has been recently diagnosed in 6-12% of patients affected with incidentally discovered adrenal masses. Some of these patients have been described to show transient hypoadrenalism after surgery, similarly to those affected with overt Cushing's syndrome. We studied a 70-year-old male patient with a large left adrenal mass, incidentally discovered, who displayed 24-h urinary free cortisol levels at the upper limit of the normal range, normal dexamethasone overnight and low-dose suppression tests and not suppressed ACTH levels, increased 17-hydroxyprogesterone response to ACTH stimulation and low upright plasma renin activity with normal serum aldosterone levels; furthermore, DHEAS level was low and 75 Selenium-cholesterol scintigraphy showed unilateral uptake concordant with the side of the mass. Soon after left adrenalectomy, he complained of acute hypoadrenalism requiring cortisol replacement therapy. ten months after surgery he is still hypoadrenal. Moreover, stimulated 17- hydroxyprogesterone and plasma renin activity in clino- and orthostatic posture have become normal. We propose that conventional dexamethasone suppression-rests may be not enough sensitive in this kind of patients and that in selected cases the absence of controlateral uptake at scintigraphy may be more reliable in predicting post-surgical hypoadrenalism.

Original languageEnglish
Pages (from-to)501-504
Number of pages4
JournalJournal of Endocrinological Investigation
Volume20
Issue number8
Publication statusPublished - Sep 1997

Fingerprint

Cushing Syndrome
Adrenal Insufficiency
Dexamethasone
17-alpha-Hydroxyprogesterone
Renin
Radionuclide Imaging
Adrenocorticotropic Hormone
Hydrocortisone
Adrenalectomy
Selenium
Aldosterone
Posture
Reference Values
Cholesterol
Adrenal incidentaloma
Serum
Therapeutics

Keywords

  • Adrenal incidentaloma
  • Adrenal scintigraphy
  • Dexamethasone suppression-tests
  • Post-surgical hypoadrenalism
  • Pre-Cushing's syndrome

ASJC Scopus subject areas

  • Endocrinology

Cite this

Pre-Cushing's syndrome not recognized by conventional dexamethasone suppression-tests in an adrenal 'incidentaloma' patient. / Torlontano, M.; Zingrillo, M.; D'Aloiso, L.; Ghiggi, M. R.; Di Cerbo, A.; Scillitani, A.; Petracca-Ciavarella, G.; Liuzzi, A.

In: Journal of Endocrinological Investigation, Vol. 20, No. 8, 09.1997, p. 501-504.

Research output: Contribution to journalArticle

Torlontano, M, Zingrillo, M, D'Aloiso, L, Ghiggi, MR, Di Cerbo, A, Scillitani, A, Petracca-Ciavarella, G & Liuzzi, A 1997, 'Pre-Cushing's syndrome not recognized by conventional dexamethasone suppression-tests in an adrenal 'incidentaloma' patient', Journal of Endocrinological Investigation, vol. 20, no. 8, pp. 501-504.
Torlontano, M. ; Zingrillo, M. ; D'Aloiso, L. ; Ghiggi, M. R. ; Di Cerbo, A. ; Scillitani, A. ; Petracca-Ciavarella, G. ; Liuzzi, A. / Pre-Cushing's syndrome not recognized by conventional dexamethasone suppression-tests in an adrenal 'incidentaloma' patient. In: Journal of Endocrinological Investigation. 1997 ; Vol. 20, No. 8. pp. 501-504.
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